The Gambia

Strengthening health management: experience of district teams in The GambiaCatherine P Conn, Paul Jenkins, And Saihou Omar Touray, 1996, Health Policy and Planning; 11(1): 64-71
Manager effectiveness was often limited by the policy and practice of the national level government and donor agencies, e.g.: the degree to which decision making was centralized on issues of staffing, budgeting, and planning, and by the extent to which national level managers have lacked skills and motivation for management change.
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